Provider Demographics
NPI:1124079942
Name:LLOYD, ANDREA MARIE (OD)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:MARIE
Last Name:LLOYD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3708 HWY 63 N
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55906-3902
Mailing Address - Country:US
Mailing Address - Phone:507-281-0657
Mailing Address - Fax:507-281-4614
Practice Address - Street 1:3708 HWY 63 N
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55906-3902
Practice Address - Country:US
Practice Address - Phone:507-281-0657
Practice Address - Fax:507-281-4614
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2318152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNU18744Medicare UPIN